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Global risk assessment tool could place millions on statin therapy

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The new cholesterol guidelines released in November 2013 have identified four major primary- and secondary-prevention patient groups who should be treated with statins. As referenced in a video in a related examiner article, “if implemented by the medical community, this could result in millions of individuals now being placed on statin therapy, who previously would not have been considered for statin therapy.

This would also mean that these individuals would be exposed to the adverse statin side effects. An article published in medscape.com quoted Dr Neil Stone (Northwestern University Feinberg School of Medicine, Chicago, IL), the chair of the expert panel who wrote the guidelines,"In the primary-prevention-therapy decisions, we insisted that the patient and the physician have a discussion to determine what the benefits and risks are specifically for that patient." This would be expected to include adverse statin side effects.

The research supporting the revised cholesterol guidelines includes the recommendation that statin drugs were the only drug therapy found effective for the treatment of elevated LDL’s, thus eliminated other popular and well documented pharmaceutical therapies as effective.

The revised cholesterol guidelines also include a new global risk assessment calculator for assessing patient's degree of risk, of an initial cardiovascular event and stroke. This assessment tool targets larger numbers of patients for statin treatment. However in an article by Ridker and Cook the risk calculator is being challenged for not having "been prospectively tested for its accuracy in predicting cardiovascular risk" and it "appears to overestimate observed risks".

Dr. Paul M. Ridker and Dr. Nancy Cook, two Harvard Medical School professors, also noted, in a thelancet.com journal article, that “the new risk calculator overestimates risk by 75 to 150 percent, depending on the population.” The authors also noted that; “This overestimated risk can move patients who would not have previously been categorized as … no treatment recommended … to … prescribe a statin”.

As noted in a NYtimes.com article, after testing the new risk calculator for hypothetical patients, Dr. Steven Nissen, a former president of the American College of Cardiology, concluded that; “If we use this new calculator, it would lead to almost all healthy men over the age of 60 getting treated with a statin, even if they’re in the lowest-risk group.

The guideline developers disagree, in part because the risk scores includes a population from racially and geographically diverse cohort studies such as the Atherosclerosis Risk in Communities (ARIC) study, and the Cardiovascular Health Study (CHS), the Coronary Artery Risk Development in Young Adults (CARDIA), and the Framingham Heart Study (FHS).

This information is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical/nutritional/fitness advice. Information presented is subject to change as additional discoveries are made or additional research is published.

Additional information: http://www.cardiosource.org/

Sources: http://content.onlinejacc.org/, http://www.nytimes.com/, http://circ.ahajournals.org/, https://www.lipid.org/, http://www.jaccjournaloftheacc.com/inpress/, http://en.wikipedia.org/wiki/, http://www.sciencebasedmedicine.org/new-cholesterol-guidelines/, http://www.cardiosource.org/News-Media/Publications/Cardiology-Magazine/2013/11/New-Risk-Assessment-and-Cholesterol-Guidelines-Spark-Debate.aspx; http://www.medscape.com/viewarticle/814152, http://en.wikipedia.org/wiki/NHLB, http://my.clevelandclinic.org/default.aspx, http://www.webmd.com/cholesterol-management/ldl-cholesterol-the-bad-cholesterol; The Lancet. Comment published online November 19, 2013 http://dx.doi.org/10.1016/S0140-

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